Catastrophic Care: How American Health Care Killed My Father—and How We Can Fix It

A visionary and completely original investigation that will change the way we think about health care: how and why it is failing, why expanding insurance coverage will only make things worse, and how it can be transformed into a transparent, affordable, successful system.

In 2007, David Goldhill's father died from a series of infections acquired in a well-regarded New YorkA visionary and completely original investigation that will change the way we think about health care: how and why it is failing, why expanding insurance coverage will only make things worse, and how it can be transformed into a transparent, affordable, successful system.

In 2007, David Goldhill's father died from a series of infections acquired in a well-regarded New York hospital. The bill was for several hundred thousand dollars--and Medicare paid it. These circumstances left Goldhill angry and determined to understand how it was possible that world-class technology and well-trained personnel could result in such simple, inexcusable carelessness--and how a business that failed so miserably could be rewarded with full payment. Catastrophic Care is the eye-opening result. Goldhill explicates a health-care system that now costs nearly $2.5 trillion annually, bars many from treatment, provides inconsistent quality of care, offers negligible customer service, and in which an estimated 200,000 Americans die each year from errors. Above all, he exposes the fundamental fallacy of our entire system--that Medicare and insurance coverage make care cheaper and improve our health--and suggests a comprehensive new approach that could produce better results at more acceptable costs immediately by giving us, the patients, a real role in the process....more

Hardcover, 384 pages

Published
January 8th 2013
by Knopf
(first published January 1st 2011)

Community Reviews

The fundamental message of Catastrophic Care is that our health care spending in the US is unsustainable because free market forces are almost entirely absent from the health care industry and bureaucracy. Wherever you are the political spectrum on the health care issue, it's worth a read to make you think more deeply about the issue.

Steven Johnson introduced the term "peer progressive" in Future Perfect: The Case for Progress in a Networked Age to encompass those of us (and I find myself in theThe fundamental message of Catastrophic Care is that our health care spending in the US is unsustainable because free market forces are almost entirely absent from the health care industry and bureaucracy. Wherever you are the political spectrum on the health care issue, it's worth a read to make you think more deeply about the issue.

Steven Johnson introduced the term "peer progressive" in Future Perfect: The Case for Progress in a Networked Age to encompass those of us (and I find myself in the "us") who are generally socially liberal and who believe that free market forces evolve the best outcomes, who believe that many small, diverse and decentralized efforts trump large, centralized planning, but who also believe that there is a need for a safety net when people are inevitably displaced by changing markets and societal trends.

Goldhill spends much of the book demonstrating that because our health care ecosystem demonstrates as it's own separate island, disconnected from market forces, we get both much higher costs and also worse outcomes. Because consumers (all of us) pay for healthcare almost entirely through intermediaries (medical insurance, Medicare, Medicaid), we do not have either the power or the responsibilities that we have as consumers of other products. One could look at the expansion of health care and the profits being generated as the result of evil corporations, but Goldhill shows that those companies and organizations are doing what companies do given the incentives. In normal markets prices and levels of service are controlled by open competition, but in the case of health care, the opacity of the system and the emotional/stress of when we actually need it combine to stifle competitive forces.

Not that Goldhill puts all the blame on the system. In my favorite paragraph of the book, he says: "The dysfunctional, unsutainable, and dangerous health care system America has built is not merely a result of the errors of our leaders; it was designed in service to a wish - our wish. We don't want to know the truth about health care, so we've built a system whose main accomplishment is shielding us from reality." When it comes to health care, that frankly describes me at least - I'd rather not think about it, just tell me who to see and what to pay, and I'll do it.

Unlike many other books on the subject, the solutions Goldhill proposes take into account actually paying for this over the long run, starting from where we are now, while also providing a strong safety net for those not able to pay the full amount for themselves. It would require all of us to take a much more active role in managing our health care, especially paying for it and being better consumers. But the tradeoff would be a health care system that is both cheaper and qualitatively better. I have to say that after thinking about several models, I am swayed Goldhill's arguments. I hope he gets traction with this at the political level, but I worry that if there's any group that is more disconnected from market forces than health care, it's politician (of all stripes). They have very little skin in this game besides making partisan points, and very little reason to make hard decisions.

If you want to take a look other aspects of this, take this book, T.R. Reid's The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care, and Steven Brill's excellent Time article on the cost of health care. Reid gives a perspective on how other development nations handle health care, and in many cases the details are somewhat different than the "centralized bureaucracy" view we often get from our media. Brill has less answers, but gets into great detail on where the costs come from in our current system.

Finally, I was struck by how similar our health care and educational systems are. Both are large systems where we want everyone to have an opportunity, that have a large component of government and political involvement, and that we are trying to manage by imposing standardized solutions and metrics upon. It seems reformers of each of the systems might learn from one another.

My only minus is that I thought it was a maybe 50-100 pages (paperback sized pages) too long and could have been condensed a bit. Still, very worth reading....more

David Goldhill does a very good job of laying out many of the biggest issues in US health care pricing, a field I actually happen to know a lot about. From his experience running a company and being on the board of the Leapfrog Group, Goldhill is in a good position to understand the excessive, and growing, costs of our current system to individuals and companies, as well as the challenges in achieving price and quality transparency in health care.

Although he superficially comes out against the ADavid Goldhill does a very good job of laying out many of the biggest issues in US health care pricing, a field I actually happen to know a lot about. From his experience running a company and being on the board of the Leapfrog Group, Goldhill is in a good position to understand the excessive, and growing, costs of our current system to individuals and companies, as well as the challenges in achieving price and quality transparency in health care.

Although he superficially comes out against the ACA, he seems to accept that it was the only thing politically possible at the time, though he would have liked something even more extreme. The short period of history since the book has been published has not been too kind regarding some of his speculative criticisms of the ACA. In particular, he suggests that the uninsured population may actually increase after the introduction of the ACA, when in fact it has decreased by about 10 million. His arguments against the ACA are some of the weaker parts of the book. One good point he does make about the ACA is that despite all the uproar, it actually affects a relatively small percentage of the population.

Where the book shines is in laying out the fundamental problems with our health care system regarding the relationships between health plans (a.k.a., health insurance companies, insurance carriers and payers), medical providers, employers and employees and their dependents. The financial incentives for providers have inevitably brought us to the situation where fee for service leads providers to perform more (and more costly) procedures. Similarly, health plans acting as third party administrators of self funded plans for medium to large employers. generally, those with more than 1,000 employees, are incented by higher volumes. Some of this is being addressed by Accountable Care Organizations and corrections to the Medicare reimbursement system, but it is the tip of the iceberg.

Goldhill also does a fantastic job of explaining how and why so much unneeded care is performed, and why it is not only economically bad, but actually produces worse clinical outcomes. More care can be worse. But, he also understands that in the extreme case of the heat of the moment when a family member or loved one is very ill, it can be very hard not to want the doctors to do everything possible to save them, regardless of cost or likelihood of success. Since the max out of pocket on insurance plans is roughly around $10k, the costs aren't typically borne by the family, but are spread across everyone in higher premiums....more

I'm only 50 pages in, and I pretty much want to underline every other paragraph and blog about every bit of it. So well thought-out and explained. So far, I think this should be a textbook for students and mandatory reading for every politician.... EXCELLENT. I dog-eared so many pages and read it aloud to my husband and talked about it animatedly several times. The whole book is clear, well researched, carefully considered and easy to understand. Even for a politician. Goldhill lays out a greatI'm only 50 pages in, and I pretty much want to underline every other paragraph and blog about every bit of it. So well thought-out and explained. So far, I think this should be a textbook for students and mandatory reading for every politician.... EXCELLENT. I dog-eared so many pages and read it aloud to my husband and talked about it animatedly several times. The whole book is clear, well researched, carefully considered and easy to understand. Even for a politician. Goldhill lays out a great solution at the end of the book, but of course, our society will have to have a major catastrophe in care, indeed, for anyone to even consider changing the whole way we deliver and "insure" health care. But it would be wonderful if we could start that change now before things do get horrific....more

Goldhill's father died as a result of medical error in a hospital that then billed insurance and Goldhill's mother $635K for the "care." The author directed his pain and anger to an outsider's examination of America's health care system. The result is a clear, richly exemplified description of the structural features of American health care that inevitably lead to excessive cost, poor quality, and systemic disregard for the best interests of the "customer." Among the possible solutions GoldhillGoldhill's father died as a result of medical error in a hospital that then billed insurance and Goldhill's mother $635K for the "care." The author directed his pain and anger to an outsider's examination of America's health care system. The result is a clear, richly exemplified description of the structural features of American health care that inevitably lead to excessive cost, poor quality, and systemic disregard for the best interests of the "customer." Among the possible solutions Goldhill proposes, I believe that consumerization of health care on a massive scale is the most promising....more

This is, quite simply, an outstanding book. Health care is an incredibly complex topic, but Goldhill's approach is to keep a laser focus on incentives. His main theme is how we misguidedly treat healthcare as a unique industry, and disassociate the consumer (and his/her spending choices) from the providers, who then have no incentive to improve.

The author is a Democrat, but began to examine his predilections after watching the death of his father (who walked into a highly regarded hospital withThis is, quite simply, an outstanding book. Health care is an incredibly complex topic, but Goldhill's approach is to keep a laser focus on incentives. His main theme is how we misguidedly treat healthcare as a unique industry, and disassociate the consumer (and his/her spending choices) from the providers, who then have no incentive to improve.

The author is a Democrat, but began to examine his predilections after watching the death of his father (who walked into a highly regarded hospital with pneumonia, and 5 weeks later was dead). He does not fall prey to the simplifications or misguided motivations of either "side" of the inter-party debate. Indeed, his final policy recommendations are a unique combination of elements.

Among the specific thematic points:- How ridiculous it is to call what we have "insurance" (which, by definition, is a distribution of risk across a population) - when 100% of "insured" people bear costs- How almost all policy decisions seem to be based on a fix lump of "health care needs" rather than contemplating how the policy will adjust needs to match incentives. Thus, over time, costs will grow to infinity because our approach (and those of most other countries, including those with single-payer systems) guarantees that care costs will grow because incentives are there for them to do so...period. Neither insurance companies nor government is a good steward of cost control- How much we (each) spend on health care over our lives, through premiums, taxes, etc. It totals, for the majority of us, to be multiple millions.

Anyway, the concepts are too numerous to mention. Suffice it to say that, in an average non-fiction book, I probably highlight about 30 passages as being particularly striking or meaningful. In this book, that total is in the 100s.

If you really, really want to catch up with what is broken in our system, and how most of us choose to look the other way and/or over-simplify the answer, read this book. It takes attention and focus, but it will be worth it, and you will be much more informed in the inevitable continued debates to come. ...more

Phenomenal analysis of the problems of the American health care market and its out-of-control "costs." Goldhill, a self-described liberal Democrat (but also a highly successful businessman) makes a very convincing case for the need for free-market reforms. The root of the argument is simple -- if nobody making the buying decisions knows what the prices are or the real costs or values that lie behind them, no real market can function. The domination of the market by "insurance" that we expect toPhenomenal analysis of the problems of the American health care market and its out-of-control "costs." Goldhill, a self-described liberal Democrat (but also a highly successful businessman) makes a very convincing case for the need for free-market reforms. The root of the argument is simple -- if nobody making the buying decisions knows what the prices are or the real costs or values that lie behind them, no real market can function. The domination of the market by "insurance" that we expect to pay for every single expenditure is a catastrophe.

Insurance is a good vehicle for covering rare and unpredictable costs that could happen to anyone (or anyone who would buy coverage) but rarely or never happen to any given person in any given year. It is a terrible vehicle for paying for predictable, normal costs that happen to everyone, all the time. Insurance to pay for massive medical expenditures makes sense, but insurance to pay for routine care, EVEN for those with expensive chronic conditions like diabetes, etc., does not make sense. You don't use homeowner's insurance to pay for a new roof when your old one is aging out after 20 years. You save up a little at a time, if you're smart, and after 20 years you have enough to pay for the replacement. If you're not a saver, you borrow from the roofing company or the bank at interest, which will cost you more. But if you used some sort of insurance vehicle to pay for this cost, it would cost you a LOT more than borrowing from the bank. AND you'd be beholden to the insurance company for who could do the roofing work, how much you'd pay, what kind of shingles, etc.

People seem to think that insurance companies negotiate cheaper prices for them, and that there's no way they can afford care otherwise. But numerous studies show that cash-paying patients who negotiate end up paying less than the insurance-negotiated rates, sometimes a LOT less. In many cases, in fact, they pay LESS than the CO-PAY that a person with insurance would pay!...more

Overall, I found the book to be fair and thought-provoking, but the idea of a "Wal-mart of healthcare" sounds pretty repulsive to me. If anything, the book does a good job of explaining the complexities of health care and Goldhill does have a humane approach to the subject. I guess I just don't have as much faith as the author in a health system left to the devices of the free market.

I wanted the book to be more of a personal story and instead it was a much more political-science based representation of American healthcare. There were some extremely interesting facts - it just wasn't what I was expecting or wanting from the read.

While the author makes some good points about issues in the healthcare system and the flaws within the ACA, he approaches the issue from the standpoint of privilege and his suggestions don't really hold up for the majority of Americans.

This is a great book for those of us not in the medical or economic fields. We think we know the problems with health care? No way. Everybody should read this. The system is crazy. We spend over $8K per capita per year on health care, yet our quality of life indicators rank among the lowest of all developed nations. That's DEVELOPED nations. Why? Because the entire system is flawed and instead of throwing it out and starting over, we keep trying to fix flaws with ever-more flawed policies. It'sThis is a great book for those of us not in the medical or economic fields. We think we know the problems with health care? No way. Everybody should read this. The system is crazy. We spend over $8K per capita per year on health care, yet our quality of life indicators rank among the lowest of all developed nations. That's DEVELOPED nations. Why? Because the entire system is flawed and instead of throwing it out and starting over, we keep trying to fix flaws with ever-more flawed policies. It's like trying to fix your plumbing with duct tape. And every "fix" brings with it ever-more creative ways that physicians, hospitals, and drug companies can bill for unnecessary and even harmful tests or procedures.

And what are we paying for? How much are we paying? Why? And by the way, when did we stop being the customer? Why am I paying for someone's penis pump? Or a test for prostrate cancer on someone who would die of other causes before untreated prostate cancer would kill him. Why are we paying for blood to be taken from a dying man - whose cause of death is already known? If the hospital wants his blood or his cells, let them pay for it, not Medicare. Not us. Where else can a business make a catastrophic mistake - like killing your loved one - then collect all the costs, resulting from THEIR mistake, from Medicare. Politicians keep talking about how cheap Medicare is to administer. Administrative costs are low BECAUSE THEY SAY YES TO EVERYTHING!! Their review process is virtually non-existent.

I am unsure, however, if his solution is ideal in this country where so many Americans have a sense of entitlement. What? Pay for our own healthcare? Be responsible for illnesses that are caused by our lifestyle CHOICES? Not when those of us who make better choices are around to cover their proverbial butts....more

This is a well written book. It attempts to tackle the reality of our healthcare system in a way that sheds light on the misinformation fed to consumers and misconceptions people have. It blows Obamacare out of the water with analysis instead of liberal rhetoric. The bottom line here is that the country is screwed if we don't make drastic changes to spending and the moral hazards doctors create by tacking on additional procedures just because health insurance will cover it. The author postulatesThis is a well written book. It attempts to tackle the reality of our healthcare system in a way that sheds light on the misinformation fed to consumers and misconceptions people have. It blows Obamacare out of the water with analysis instead of liberal rhetoric. The bottom line here is that the country is screwed if we don't make drastic changes to spending and the moral hazards doctors create by tacking on additional procedures just because health insurance will cover it. The author postulates that the patient has no say in the economics of healthcare. The customer is the insurance company and typically the insurance company's customer is the employer of the patient. This seems to back up my theory that human beings are second class citizens behind corporate entities in this country. It is time to take back this country, our health and our dignity from those who would do anything for money. Goldhill makes a statement which indicates that the social function of profit is to send signals to players in the market, not to get rich. This is an idea that American capitalists seem to have forgotten long ago....more

Very good essay, questioning the relationship between money and health, health as a care, not a financial option, defined by dollars for a life

There are some odd comments in the book, such as the claim that there is no indication that paying for healthcare has resulted in death, when we know that there are many cases of people turning down healthcare because of the cost (the recent case of a cure for HIV being derived from a woman who terminated her treatment because of the cost being a case inVery good essay, questioning the relationship between money and health, health as a care, not a financial option, defined by dollars for a life

There are some odd comments in the book, such as the claim that there is no indication that paying for healthcare has resulted in death, when we know that there are many cases of people turning down healthcare because of the cost (the recent case of a cure for HIV being derived from a woman who terminated her treatment because of the cost being a case in point).

The claims of affordable healthcare for all in Singapore are also badly flawed, as are the costing models for Western Europe, where the problems can be directly linked to attempts to provide a private costing alternative for everything, giving different rules and regulations to the private sector, even allowing them to take the cream of the services, ignoring the high cost areas and thus pushing up the average cost of healthcare left in the public sector.

One must not lose sight of the primary cost problem - insurance. It is this area that is on the rise throughout the world and the finance companies must be kept under control as they seek new areas to exploit after their failings in Wall St and the mortgage markets.

1) Language matters. Why do we talk about Health Care COSTS instead of Health Care PRICES? It's wishful thinking. Is it too uncomfortable to think about putting a PRICE on grandma's care at the ED? Every bill, appointment, test, crown, filling (I'm a dentist) reflect someon's time, labor, skill. Let's call it what it is..Health Care has prices.2) Health Care isn't Health! The bottom line is that nutrition, exercise, education,refraining from tobacco use, having a faitWhy is healthcare so costly?

1) Language matters. Why do we talk about Health Care COSTS instead of Health Care PRICES? It's wishful thinking. Is it too uncomfortable to think about putting a PRICE on grandma's care at the ED? Every bill, appointment, test, crown, filling (I'm a dentist) reflect someon's time, labor, skill. Let's call it what it is..Health Care has prices.2) Health Care isn't Health! The bottom line is that nutrition, exercise, education,refraining from tobacco use, having a faith component, marriage do far more to determine longevity and quality of life than anything a doctor or hospital can do for you. 1/2 of deaths are caused by heart disease, lung cancer, suicide, homicide and accidents...all mostly affected by lifestyle choices...not health care.3) Health insurance isn't really insurance. Insurance is supposed to spread the cost of a loss among a group of people who face a loss. (Home owner's insurance for example..we all pay a few hundred a month in case our house burns down...most never use it..but for the one unfortunate person it save's their tail). Fundamentally health insurance is a payment mechanism for health care that is totally inefficient. The health insurance industry employs 500,000 workers (1 worker for every doctor). The administrative costs are 1k per family for health insurance alone.4) THis is not a BILL! Have you ever received something that says "Your Responsibility is" but "Your TOtal Responsibility to YOUR PRovider is." What does this mean? If we can't understand the bill, then we can't be informed customers and make educated decisions..just he way the health insurance industry likes it to be.5) Effective Health Care...no one has the courage to draw the line? If AVASTATIN a drug for breast cancer patients can/maybe extend the life of a patient 1 month should it be covered by medicaid? How can sociery ever afford health care if we value each month of everyone's life at $88,000?6)Imagine you had a business where your customer didn't care about the price or product and was always willing to buy. That would be the perfect customer right! Joe down the street has medicare and had a artificial knee done. He was healthy and walking immediately, but you notice a wheel chair sitting in his garage. "Hey Joe why do you have that." Oh the hospital gives one to everyone..it's covered you know.7) Excessive Care. Full Body Scan's (now popular) show abnormalities nearly 75% of the time. But upon closer investigation..only 1% require further care. Many procedures (spinal surgery, C-sections) are not unnecessary.

Brass Tacks show that the average American during the course of his life will contribute 60K to Medicare while sucking out 170K in benefits. Multiply that by our population (about 300 million)..and there you come up with the majority or our nearly 17 trillion dollar deficit.

What are the solutions?

Americans will spend roughly $8,500 per person on health care this year. That's $680,000 over a lifetime. Wouldn't it be better if this money was put in a Health Care Savings account rather than drained from your paycheck each month when you are healthy? Let's make health insurance..a real insurance with high deductible's (maybe 10 K). Health care insurance would then cost about 1k per year. We should pay for check-ups, exams, with our Health Care Account..just like we doe when we get our oil changed in our car or when we fix our roof on our house. We will be better health care consumers as well with attention to cost and service. ALso we can decide..do we want to go to CVS for a cheap Minute CLinic and see a Nurse practicioneer to get some antibiotics for our child and pay only $49 dollars. Great. But if we want full on concierge service by a private phyisican..so be it! The decision should be that of a patient.

Excellent book. 5 stars for Goldhill using tragedy (the death of his father) to investigate the health care industry. Despite him being a little too hard on doctor errors, Goldhill has a great grasp of the problems and the solutions. I wish every Senator and Congressman would read this book. ...more

Most of us have had horrible run-ins with our health care system. The author certainly has! But instead of grinning and bearing it, he actually has a prescription. It won't make any side of the current debate happy, and it may in fact be out of our societal political reach. In a nutshell, He was to relegate insurance and insurance companies to a universal, very high deductible status. He want all routine and chronic medicine to be left to the pressures of the market, so that competition can loweMost of us have had horrible run-ins with our health care system. The author certainly has! But instead of grinning and bearing it, he actually has a prescription. It won't make any side of the current debate happy, and it may in fact be out of our societal political reach. In a nutshell, He was to relegate insurance and insurance companies to a universal, very high deductible status. He want all routine and chronic medicine to be left to the pressures of the market, so that competition can lower prices and increase quality and safety. And he wants all of us to have a HSA with mandatory funding of about $8500/yearly. And He wants a government of quasi government lending function, secured by our HSA balance (and future balance since is is mandatory) to lend us any money we need before the High Deductible Insurance kicks in.

It sounds like a long term improvement is our totally dysfunctional system to me, but the Insurance companies are not going to take this lying down, nor our their 'bought' politicians. Also, there may be a little more faith in the free market than is warranted. (Unless we started enforcing anti-trust laws again and maybe regulate the advertising barrage, and set standards of care that are mandatory).

His transition actually involves a gradual work-in to this plan, beginning with the young. Current Medicare would stay on the existing schema. His plans for those that cannot afford care are maybe the weakest part of his system (calling for load forgiveness for example)

I enjoyed this volume. This is a real problem, and the author actually has an 'out of the box' proposal for a solution. I just wish I though it could be taken seriously by those in authority. ...more

This book should be required reading if one is to vote in the USA. The issue is that imperative.

Goldhill effectively hits a home run on every page, and explains in great detail why the current health system in the US is both flawed and doomed.

Are you a liberal that thinks the tea baggers are nuts for wanting to repeal ACA? This book is for you.

Are you a tea-party type that would love to see ACA repealed? This book is for you.

Are you at all concerned about our health care system or the people wanThis book should be required reading if one is to vote in the USA. The issue is that imperative.

Goldhill effectively hits a home run on every page, and explains in great detail why the current health system in the US is both flawed and doomed.

Are you a liberal that thinks the tea baggers are nuts for wanting to repeal ACA? This book is for you.

Are you a tea-party type that would love to see ACA repealed? This book is for you.

Are you at all concerned about our health care system or the people wanting to afford health care in the US? This book is for you.

I'm not just some acolyte writing this review. There are plenty of things I can take issue with. For instance, Goldhill believes that health care "should be a right." I realize that a true right will not create an obligation to others. In his chapter on what sort of system would be better than what we have now, Goldhill advocates "Health Loans" available to everyone. Look no further than the cost of college over the last 30 years to see that this idea is both flawed and a disaster; where unfettered loans have led education costs to outpace inflation since the inception of the DOE.

And what do policy makers advise? More loans. What do they advise for health care in the US? More insurance.

Read this book, even if it's the only one you read all year. It's that important....more

The subtitle of this book is "How American Health Care Killed My Father and How We Can Fix It." Mr. Goldhill thoughtfully and persuasively delivers on both parts of that subtitle. The clear thinking and meticulous research and analysis he brings to this very complex and troubling issue was a breath of fresh air. Each chapter is laid out logically, buttressed by necessary but not overwhelming data, and calmly discussed without the emotional excess one might expect from the subtitle. Mr. GoldhillThe subtitle of this book is "How American Health Care Killed My Father and How We Can Fix It." Mr. Goldhill thoughtfully and persuasively delivers on both parts of that subtitle. The clear thinking and meticulous research and analysis he brings to this very complex and troubling issue was a breath of fresh air. Each chapter is laid out logically, buttressed by necessary but not overwhelming data, and calmly discussed without the emotional excess one might expect from the subtitle. Mr. Goldhill is not looking for easy scapegoats and does not dumb down the difficulty of the challenges we face in trying to "fix" health care. He uses stories from his own life and those of other friends and family to illustrate aspects of the disfunction in our system. His solutions are creative, economically savvy, and pragmatic in terms of the time this process will take. His analysis of the weaknesses of the Affordable Care Act (Obamacare) is not idealogical but it is rigorous and thought-provoking. If this had not been a library book , my highlighter and sticky notes pack would have left the text "decorated" on nearly every page. For anyone looking for hope on this "island" of health care mismanagement, adverse outcomes, waste, and real suffering, Mr. Goldhill's book is just what we need to give us a direction forward.

Phenomenal and ground breaking. Also depressing; he is perfectly right, that the ACA is likely to drive up costs; costs have already been driven up by the lack of controls on Medicare and Medicaid and by the shift of payments from consumers to insurers. His solution for all this is a market-based solution. But he clearly doesn't know medicine. While he is correct about the problems, he envisions a solution where every patient/consumer would weigh the amount in their health savings accounts againPhenomenal and ground breaking. Also depressing; he is perfectly right, that the ACA is likely to drive up costs; costs have already been driven up by the lack of controls on Medicare and Medicaid and by the shift of payments from consumers to insurers. His solution for all this is a market-based solution. But he clearly doesn't know medicine. While he is correct about the problems, he envisions a solution where every patient/consumer would weigh the amount in their health savings accounts against how much they are willing to pay for care. This may work for an eye exam, or even a flu visit. I can't see it working well for any preventive care (which he doesn't believe in anyway) such as pap smears, well child visits, or colonoscopies. I can imagine most people making the choices that my currently uninsured patients make: to skip follow-up visits or procedures that are recommended; to forego half the medications recommended; to leave the hospital against medical advice (only to end up back a couple days later because they left too early.)

I also don't see how most of us can be smart consumers when we are, say, taken by ambulance to a hospital (not of our choice btw) for acute illness or injury. We will always be at the mercy of the system. Currently, we expect our insurers and medical ethics to protect us. If we don't think this is working, we need to demand government regulation that will. I don't think the power of free market will really ever work for this exceptional good....more

Catastrophic Care is compelling, and it will ultimately compel me to reread it and examine a good deal of criticism and complementary analysis before I could accept it asproperly digested. The fact that Goldhill inspires this kind of consideration is his book's strongest attribute. If nothing else, I'll never be fully satisfied with the notion that insurance should pay for everything. As a young type-1 diabetic, that's something significant.

You should never invest in healthcare until you read this book. It is what any thoughtful insider could tell you about what the real problem with healthcare costs really is. Sanity in an otherwise wholly emotionally covered topic dominated by political rhetoric instead of pragmatic insight that reminds us of the simple, undefeated maxim that incentives matter!!!

I'd despaired of ever understanding why and how the American system of health care turned into such a disaster. But Goldhill does a brilliant job of making that clear. Better still, he has a persuasive vision of the path to regaining safe, innovative, customer-friendly, and comprehensive medical care. We'll never get there until most Americans begin to understand the dynamics that he illuminates, but this book provides a great start to such understanding.

I was very intrigued by the premise of this book and I definitely wanted to like it. However, the author is all over the place and constantly has footnotes to random anecdotes that are extremely distracting from his actual points. I think the author should rewrite this with the help of a more established writer.

Advocates that we should be paying for health care using something the Singapore model which seems would be a lot better than the insane system we have right now. Routine health care payments would need to be paid from the users mandated (and employee/employer/government contributed) health account and large unexpected payments could be covered by taking a loan against future health account contributions (possibly including debt forgiveness) as well as payments from true catastrophic health insuAdvocates that we should be paying for health care using something the Singapore model which seems would be a lot better than the insane system we have right now. Routine health care payments would need to be paid from the users mandated (and employee/employer/government contributed) health account and large unexpected payments could be covered by taking a loan against future health account contributions (possibly including debt forgiveness) as well as payments from true catastrophic health insurance (which would NOT cover routine payments and might be offered/mandated by the government). Doctors and hospitals would have to advertise their prices and services to the consumers (in Singapore the government also directly provides 80% of the health care)....more

A sobering analysis of American health care finance - the causes of its disfunction and real solutions for its remedy. The author is convincing in his argument that there are, indeed, ways to halt the crisis we are experiencing, but actually taking action with those solutions would be extremely difficult thanks to the special interest groups that have every reason to maintain the status quo. Contains a critical analysis of the Affordable Care Act, which he argues has good intentions, but only buA sobering analysis of American health care finance - the causes of its disfunction and real solutions for its remedy. The author is convincing in his argument that there are, indeed, ways to halt the crisis we are experiencing, but actually taking action with those solutions would be extremely difficult thanks to the special interest groups that have every reason to maintain the status quo. Contains a critical analysis of the Affordable Care Act, which he argues has good intentions, but only builds on the current state of disfunction. Basically an argument for eliminating all but catastrophic care insurance, establishing health savings accounts, and allowing the free market to provide an effective, fair, and affordable solution to the health care problem....more

Good 4.4 Covers many problem areas in the delivery and financing of American health-care. Mr. Goldhill proposes some interesting plans for improvement, including coverage for medical catastrophes but increased patient-consumer responsibility for payment for more routine care and medications; the plan involves Health Care Accounts. He considers that this approach would put higher demands on the medical providers and hospitals to improve care and reduce costs. The approach would also encourage patGood 4.4 Covers many problem areas in the delivery and financing of American health-care. Mr. Goldhill proposes some interesting plans for improvement, including coverage for medical catastrophes but increased patient-consumer responsibility for payment for more routine care and medications; the plan involves Health Care Accounts. He considers that this approach would put higher demands on the medical providers and hospitals to improve care and reduce costs. The approach would also encourage patient/consumers to make good choices about treatment. He provides more details than would interest the average reader, but presents thoughtful ideas with back-up documentation of his reports....more

An expansion of an article the author wrote for the Atlantic Magazine several years ago which was "highly praised and completely ignored," this book presents an excellent analysis of our dysfunctional health care system and provides many sensible suggestions for its improvement. Written for the general reader from the viewpoint of a successful businessman, Goldhill makes the argument that a market based system that includes a catastrophic event safety net would be a vast improvement over the preAn expansion of an article the author wrote for the Atlantic Magazine several years ago which was "highly praised and completely ignored," this book presents an excellent analysis of our dysfunctional health care system and provides many sensible suggestions for its improvement. Written for the general reader from the viewpoint of a successful businessman, Goldhill makes the argument that a market based system that includes a catastrophic event safety net would be a vast improvement over the present system even with the effects of the ACA (Obamacare) taken into account. Worth a read if you are interested in the future of healthcare in this country....more

This contains quite a bit of useful information, and some great metaphors on the topic of insurance -- you wouldn't use your auto insurance for an oil change, right? He does a good job of explaining how the complicated payment system has blurred our understanding of cost. But, there are some limitations here -- he sells too much in his text. His primary experience in health care seems to be talking about it and talking about articles and books he's written on the subject. He comes across as dangThis contains quite a bit of useful information, and some great metaphors on the topic of insurance -- you wouldn't use your auto insurance for an oil change, right? He does a good job of explaining how the complicated payment system has blurred our understanding of cost. But, there are some limitations here -- he sells too much in his text. His primary experience in health care seems to be talking about it and talking about articles and books he's written on the subject. He comes across as dangerously pundit-ish, so you kind of wonder if he has enough friends or colleagues making him think about the consequences of his proposals....more

Liked the book pretty well. Author has some good ways of explaining healthcare system problems and I think his suggested solutions make sense. I wish he had not used some metaphors so frequently - he refers to US healthcare as an "island" meaning that it operates very differently than other parts of life in the US. OK that's a fine metaphor, but then he relentlessly uses the term "island" throughout the book to refer to US healthcare, which irritated me. But I liked the book anyway, and would reLiked the book pretty well. Author has some good ways of explaining healthcare system problems and I think his suggested solutions make sense. I wish he had not used some metaphors so frequently - he refers to US healthcare as an "island" meaning that it operates very differently than other parts of life in the US. OK that's a fine metaphor, but then he relentlessly uses the term "island" throughout the book to refer to US healthcare, which irritated me. But I liked the book anyway, and would recommend it to anyone who thinks the healthcare system still needs some major fixing, even post-Obamacare. ...more

“A recent Economist article on dialysis perfectly illustrates the inflationary impact of cost-plus pricing. Since U.S. clinics are paid on a cost-plus basis, they prefer to use expensive drugs rather than cheaper ones. In fact, many appear to order drugs in units that exceed what a standard dosage requires because they can charge the government for the wastage. Quoting a stock research firm, the article noted that many clinics preferred an injected drug with a price of $4,100 a year over the identical drug in oral form, priced at only $450 a year. Not surprisingly, the manufacturer of the oral drug responded by increasing its price above that of the injected version to make it more competitive!”
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“But though I admire their intentions and ambitions, I contend that they have missed the big picture: the underlying insurance-based structure of our health care system drives excess treatment, cost inflation, and medical errors. It is this structure that needs to be changed.”
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